Abstract 3029: Barriers to optimal breast cancer screening modalities for high-risk patients in the primary care setting
Authors: Yu Jen Jan, Prudence B. Lam
Journal: Cancer Research (2023)

Abstract Background: Annual screening breast MRIs are endorsed by current breast cancer screening guidelines as an adjunctive screening modality for high-risk patients (defined by more than 20% lifetime risk) in addition to a screening mammogram. Recent studies showed screening breast MRI remained underutilized despite the current recommendations. On the other hand, validated breast cancer risk models for identifying high-risk patients also remained under-recognized among primary care providers. This study aims to identify the potential barriers for primary care providers (PCPs) to using breast cancer risk models and referring high-risk patients to breast MRI for screening. Methods: An anonymous survey was distributed via email to the PCPs and OB/GYN providers in the network of Mount Auburn Hospital, a community teaching hospital affiliated with Harvard Medical School in Cambridge, Massachusetts. The survey included questions regarding breast cancer screening in average-risk and high-risk patients, providers’ understanding of breast cancer risk models, and current referral status of breast MRIs and high-risk/genetic clinics. Results: The survey was sent to 104 providers, and 43 responses were received. When asked about performing breast cancer risk assessments, 58% reported “Always (91-100%)” and 33% said “Often (71-90%)”. For factors to consider when performing risk assessments, most of the providers considered personal medical history (98%), family history (100%), genetic syndrome history (86%), and previous breast biopsy results (90%). When asked about breast cancer risk models, 58% of the providers had not heard of or used one. 33% of the providers have used the Gail model, and 26% have used the Tyrer-Cuzick model. 51% of the providers correctly identified high-risk as lifetime risk &amp;gt;20%. 56% correctly answered annual mammograms with MRI for breast cancer screening for high-risk patients. The majority of the providers (84%) would prefer to refer patients to the high-risk clinic for risk assessment and screening management. For barriers to referring to MRI, the insurance approval process (49%) was reported to be the largest barrier. 72% of the providers prefer not ordering it and defer to the high-risk/genetic clinic for ordering the test. Conclusions: Our survey has shown different barriers to breast cancer screening in high-risk patients in the primary care setting, including knowledge and logistic barriers. Further education for PCPs is needed for correctly identifying high-risk patients, utilizing risk models, and referring high-risk patients for breast MRI screening. Citation Format: Yu Jen Jan, Prudence B. Lam. Barriers to optimal breast cancer screening modalities for high-risk patients in the primary care setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3029.